Prevalencia e impacto clínico de las enfermedades reumatológicas autoinmunitarias sistémicas en pacientes con silicosis

BackgroundSilicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis.MethodWe performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed.ResultsOverall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0 vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030).ConclusionsThe presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.     

Impacto terapéutico de las estatinas en el perfil lipídico y el riesgo cardiovascular en pacientes con lupus eritematoso sistémico: revisión sistemática de la literatura y metaanálisis

BackgroundThere is strong evidence of a rise in cardiovascular risk in patients suffering from autoimmune diseases, especially in those with Sistemic Lupus Erythematosus. Until now, there are a few trials that assess the potencial benefit of statins on the incidence of cardiovascular events and on lipid profile of patients with SLE. This evidence has not been synthesized and assessed altogether.MethodsWe performed a search in databases of literature published until August of 2016 (Embase, MEDLINE, Cochrane Library, SciELO, Clinical Evidence, DynaMed, Cochrane Central Register of Controlled Trials, LILACS), identifying controlled clinical trials that could estimate the impact of statins on mortality, cardiovascular events, C-reactive protein and lipid profile in patients with Systemic Lupus Erythematosus. The quality of the information available was assessed with a meta-analysis, using a random effects model, employing the RevMan 5.3 software.Results6 trials and 412 patients were included in the analysis. The use of statins in patients with SLE was found to significantly reduce the levels of serum total cholesterol (mean difference [MD] –31,4 mg/dL; CI 95% –43,0; –19,9), and serum low density cholesterol (MD –31,4 mg/dL; IC 95% –43,0; –19,9), but had no impact on levels of serum triglycerides (MD 4 mg/dL; IC 95% 2,49; 6,21) and C-reactive protein (MD –0,78; IC 95% –1,43; –0,13). No evidence was found about the impact on the risk of mortality or cardiovascular events.ConclusionStatins have a significant effect on the levels of serum total cholesterol, LDL cholesterol and C-reactive protein, however, more randomized controlled trials with long-term follow-up are necessary to assess the impact on mortality and cardiovascular risk.     

Utilidad de la ecografía extraarticular aplicada a las enfermedades inflamatorias sistémicas en la práctica clínica

Ultrasound is a non-invasive, innocuous, reproducible, cost-efficient imaging technique that provides immediate information, as it can be performed in our consultations. The good profile of ultrasound and the technological advances that have taken place in recent years, which have allowed a substantial improvement in the resolution of the image to make it almost anatomical, have promoted research on its application in the comprehensive study of systemic inflammatory diseases. At present, the threshold of using ultrasound to exclusively investigate musculoskeletal manifestations has been crossed, to also apply it to the study of extra-articular manifestations and comorbidities associated with rheumatic diseases. In this review we will revise its usefulness for the diagnosis of glandular involvement in Sjögren's syndrome, interstitial lung disease or giant cell arteritis and for stratification of cardiovascular risk in patients with chronic inflammatory rheumatic diseases.     

Niveles de propéptido aminoterminal de procolágeno tipos i y iii y gravedad de la enfermedad pulmonar intersticial en mujeres mexicanas con esclerosis sistémica progresiva

BackgroundInterstitial lung disease (ILD) is a frequent complication in progressive systemic sclerosis (SSc), being present in 25% to 90% of cases.ObjectivesTo evaluate whether serum levels of procollagen type i and iii aminoterminal propeptide (PINP and PIIINP) correlate with severity and patterns of ILD in Mexican women with SSc.MethodsThirty three SSc patients were assessed for disease characteristics and anti-topoisomerase antibodies (topo i), and also underwent pulmonary function tests and high-resolution computed tomography (HRCT). Nineteen patients had ILD + SSc, and 14 had no lung involvement (no ILD-SSc); data were compared with those from 45 healthy controls. PINP and PIIINP were assessed in all 3 groups.ResultsPatients with SSc had higher PINP and PIIINP vs controls (P = .001, P < .001, respectively). Compared to no ILD-SSc patients, those with ILD + SSc had longer disease duration in years (P = .005), higher modified Rodnan skin score (P < .001), higher Health Assessment Questionnaire-Disability-Index scores (P < .001), higher topo i U/mL (P < .001), PINP (49.28 ± 28.63 vs. 32.12 ± 18.58 μg/L, P = .05), and PIIINP (4.33 ± 1.03 vs. 2.67 ± 1.26 μg/L, P < .001) levels. ILD severity based on total HRCT correlated with PINP (r = .388, P = .03) and PIIINP (P = .594, P < .001). On adjusted analysis, ILD severity was associated with disease duration (P = .037), PIIINP (P = .038), and topo i (P = .045).ConclusionsPINP and PIIINP are useful markers for severe ILD + SSc, suggesting they could play a role in the follow-up of this complication in SSc.     

Recomendaciones de la Sociedad Española de Reumatología sobre el tratamiento y uso de terapias sistémicas biológicas y no biológicas en artritis psoriásica

Objective

The main purpose of this recommendation statement is to provide clinicians with the best available evidence and the best opinion agreed upon by the panelists for a rational use of synthetic disease modifying antirheumatic drugs (DMARDs) and biologicals in psoriatic arthritis (PsA) patients. The present document also focuses on important aspects in the management of PsA, such as early diagnosis, therapeutic objectives, comorbidities and optimization of treatment.

Cambios radiográficos del penacho de la falange distal de las manos en pacientes con esclerosis sistémica. Revisión sistemática

Objective

To determine abnormal plain radiograph findings of the distal phalanx tuft of the hand (DPTH) associated with systemic sclerosis in adults.

Intersticiopatía pulmonar subclínica en pacientes con esclerosis sistémica. Estudio piloto sobre el papel del ultrasonido

IntroductionInterstitial lung disease (ILD) is a common comorbidity present in patients with systemic sclerosis (SSc). Employment of high-resolution computed tomography (HRCT) is very limited and lung ultrasound (LUS) can be an alternative tool for the early evaluation of ILD.ObjectiveTo determine the validity of LUS in the early detection of ILD in patients with SSc.MethodsSixty-eight patients with SSc ≥18 years without respiratory symptoms were included. A rheumatologist rated the subclinical respiratory condition, another rheumatologist blinded to the clinical assessment performed the LUS. To determine validity HRCT was performed as well.ResultsPrevalence of ILD in SSc patients was 41.2% in contrast to the 4.8% healthy controls (P = .0001). Variables associated with LUS and HRCT findings were anti-centromere antibodies (P = .005) and the Rodnan skin score (P = .004). A positive correlation was present between the findings of HRCT and LUS (P = .001). Sensitivity and specificity were 91.2% and 88.6% respectively. Good reliability in the LUS findings was found between observers (k = .72).ConclusionsBy proving to be a valid, trustworthy and feasible alternative tool, we consider that LUS can be implemented for the early detection of ILD in SSc.     

Tratamiento con esteroides sistémicos en agudización grave de enfermedad pulmonar obstructiva crónica: empleo de pautas cortas en práctica clínica habitual y relación con la estancia hospitalaria

Introduction

It is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short coursesofsystemic corticosteroids(SC-SCS) are followed in clinical practice.

Impacto de las nuevas guías estadounidense y británica en el manejo y el tratamiento de las dislipemias en una población laboral española

Introduction and ObjectivesThe guidelines of the American College of Cardiology/American Heart Association and the British National Institute for Health and Clinical Excellence on the management and treatment of dyslipidemia recommend significant changes, such as the abolition of therapeutic targets and the use of new risk tables. This study aimed to evaluate the impact of the use of these new guidelines compared with the application of European guidelines.MethodsObservational study conducted among Spanish workers. We included all workers registered with the Sociedad de Prevención de Ibermutuamur in 2011 whose cardiovascular risk could be evaluated. Cardiovascular risk was calculated for each worker using the Systematic Coronary Risk Evaluation cardiovascular risk tables for low-risk countries, as well as the tables recommended by the American and British guidelines.ResultsA total of 258 676 workers were included (68.2% men; mean age 39.3 years). High risk was found in 3.74% of the population according to the Systematic Coronary Risk Evaluation tables and in 6.85% and 20.83% according to the British and American tables, respectively. Treatment would be needed in 20 558 workers according to the American guidelines and in 13 222 according to the British guidelines, but in only 2612 according to the European guidelines. By following the American guidelines, the cost of statins would increase by a factor of 8.ConclusionsThe new recommendations would result in identifying more high-risk patients and in treating a larger fraction of the population with lipid-lowering drugs than with the European recommendations, which would result in increased costs.Full English text available from: www.revespcardiol.org/en     

Relación de las profesiones y las condiciones laborales con la neumonía adquirida en la comunidad

IntroductionCommunity-acquired pneumonia (CAP) is not considered a professional disease, and the effect of different occupations and working conditions on susceptibility to CAP is unknown. The aim of this study is to determine whether different jobs and certain working conditions are risk factors for CAP.MethodologyOver a 1-year period, all radiologically confirmed cases of CAP (n = 1,336) and age- and sex-matched controls (n = 1,326) were enrolled in a population-based case-control study. A questionnaire on CAP risk factors, including work-related questions, was administered to all participants during an in-person interview.ResultsThe bivariate analysis showed that office work is a protective factor against CAP, while building work, contact with dust and sudden changes of temperature in the workplace were risk factors for CAP. The occupational factor disappeared when the multivariate analysis was adjusted for working conditions. Contact with dust (previous month) and sudden changes of temperature (previous 3 months) were risk factors for CAP, irrespective of the number of years spent working in these conditions, suggesting reversibility.ConclusionSome recent working conditions such as exposure to dust and sudden changes of temperature in the workplace are risk factors for CAP. Both factors are reversible and preventable.     

Tratamiento con rituximab para las miopatías necrosantes autoinmunes asociadas al anti-SRP: caso clínico y revisión de la evidencia

Necrotizing autoimmune myopathy (NAM) is a rare and emerging entity of idiopathic inflammatory myopathy (IIM).They have been associated with connective tissue disorders, viral infections, malignancy, anti-signal recognition particle (SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase protein (with or without the use of statins).Anti-SRP associated NAM has different clinical and histological characteristics that differentiate them from other IIM, resulting in a poor prognosis. Very few cases treated with rituximab have been published, with varying clinical response.Here we describe a case of anti-SRP associated NAM refractory to conventional immunosuppressants and its successful long-term management with the combination of rituximab, corticosteroids and methotrexate.     

Utilidad de la tomografía computarizada de 64 detectores en el diagnóstico y el manejo de los pacientes con cardiopatías congénitas

Introduction and ObjectivesAlthough congenital heart defects are the most common major congenital abnormalities, the associated mortality has been decreasing due to improvements in their diagnosis and treatment. We assessed the usefulness of 64-multidetector computed tomography in the diagnosis and management of these patients.MethodsThis 5-year observational, analytical, retrospective, cohort study included a total of 222 tomographic studies of patients with congenital heart disease. Computed tomography scans were read twice and medical records were reviewed. We assessed the complexity of the disease, patient, and radiological technique, and evaluated the contribution of new data in relation to clinical suspicion and diagnostic change. A confidence interval was set at 95% and a P value of < .05 was used as the cutoff for statistical significance.ResultsIn 35.1% of patients, the treatment procedure was performed after computed tomography without other tests. Additional diagnostic catheterization was performed in 12.5% of patients. There were new findings in 77% of patients (82.9% with complex disease), which prompted a change in patient management in 35.6%. All unexpected reports described new findings. No significant differences were found by age, sex, study period, urgency of the test order, patient complexity, or difficulty of the technique.ConclusionsUse of 64-detector computed tomography yields good diagnostic performance in congenital heart disease, prompts changes in management in more than one-third of patients, and reveals new findings in relation to the presumed diagnosis in 77% of patients.Full English text available from: www.revespcardiol.org/en     

¿Son necesarias las dosis elevadas de prednisona para el tratamiento de la neumopatía intersticial en la esclerosis sistémica?

IntroductionInterstitial lung disease (ILD) as part of systemic sclerosis (SS) is a leading cause of morbidity and mortality.ObjectivesTo evaluate the use of intravenous pulse cyclophosphamide combined with low and high doses of prednisone in the treatment of ILD in SS is equally effective.MethodAn experimental, exploratory and randomized single-blind clinical trial was conducted at Hermanos Ameijeiras Clinical Surgical Hospital from September 2006 to December 2009, including 23 patients with SS and ILD. Two treatment schedules were evaluated and randomly assigned. Group A was composed of 13 patients with a monthly dose of cyclophosphamide (ev) for 6 months and a twice-monthly dose for the remaining 6 months, prednisone (1 mg × kg × day) 4 weeks and then the dose was lowered to 5 mg every 2 weeks up to 10 mg. Group B: 10 patients with cyclophosphamide (ev), oral prednisone 10 mg daily.ResultsThere are significant differences at onset of CVF and the honeycomb pattern between both groups, where the high dose group was at a disadvantage. At the end of treatment the low dose group achieved improvement of radiologic lesions and the Warrick index, unlike the high dose group. The remaining variables experienced improvement in both groups without marked inequality. Similarly, slight adverse reactions were present in both groups. Two patients dropped out of the study.ConclusionsA combination of low dose steroids with cyclophosphamide is effective in interstitial lung disease treatment especially in active disease, and results did not showe differences regarding the high dose group but the sample size and the evolutionary severity of high dose patients oblige other studies to verify this data.